About Me

Wednesday, June 9, 2010

Hospital Experience #3: Panic

In my two previous posts, I described (1) the background leading to a recent hospital experience and (2) the hospital experience itself. This post will explore the panic I experienced in the room where my procedure (cardiac catheter ablation to correct a heart arrhythmia) was performed.

First, I will mention that I was amazingly calm (for me) in the weeks and days leading up to hospital day. In fact, I did fairly well until I was taken to the room where the cardiac catheter ablation was to be performed and the medical team began to hook me up to the various monitors.

Before I go any further, I want to mention that my doctor and the members of the medical team were competent, professional, and kind. I sensed that they truly wanted to help me. The problem did not lie in the way I was treated - I was treated in a caring way.

THE FACTS OF WHAT HAPPENED

These are the facts of what happened, as I understand them.

Once in the procedure room, I was initially asked to sit up while patches (to which wires were attached at one end, with the other end attached to the monitors) were applied to my back. At this point, I was fine.

Then I was asked to lie down, and as the doctor or a member of the medical team explained to me what they were doing at each step, the following things were done. These steps are not necessarily in order, and some were being done simultaneously.

More patches were applied to my abdomen and chest.

My groin area was shaved.

My arms were secured at my sides.

A clear plastic triangle was placed over my nose to administer oxygen and air under pressure. The pressure was to keep my airway open throughout the procedure, as I have sleep apnea and use a C-PAP (Continuous Positive Airway Pressure) machine when I sleep.

Potassium was administered through my IV, as blood drawn that morning had indicated that my potassium level was a little low. (This was probably because I had fasted the previous day.) The doctor explained that the potassium would cause a burning sensation temporarily and asked if I was ready to receive it, to which I said okay. Indeed, it did produce quite an unpleasant burning sensation.

As these things were being done, I was moving more and more into panic. Perhaps it wasn't technically panic (I can imagine several levels beyond what I experienced), but it was at least extremely high anxiety bordering on panic - or maybe it was technically panic. It began when I had to lie flat, and it was considerably exacerbated when my arms were secured and when the potassium was administered. It was manifested in these ways.

Jerking whenever someone touched me

Hyper-ventilating

Trembling

Crying out

Struggling against the arm restraints (which were simply sheets that were wrapped comfortably around my arms and then secured to the bedside and that did allow some movement - please don't imagine tight leather straps or chains!)

Eventually reaching a state where I felt that I was going to faint, even though I was lying completely flat

This panic did not go on very long. The doctor stopped the administration of potassium through the IV (at least I heard her say, "Okay, stop the potassium"), since I was crying out that it was burning my arm, I was hyperventilating and trembling and jerking, and I said that I felt I was going to faint. It seems to me that the sedative was then administered through the IV. This worked. I could feel myself calming way down and relaxing. This was a nice feeling! I imagine that a calmed patient was nice for the doctor and the medical team as well! For the rest of the time in the procedure room, I was sometimes lightly unconscious and sometimes comfortably and drowsily aware.

MY THOUGHTS ABOUT WHAT HAPPENED

First, I was out of control. It is hard for me to imagine how I could have maintained control of my behavior - stayed calm, breathed deeply, held still. I think I can say that I wasn't capable of such control under the circumstances. It does occur to me that I could have said emphatically, "Stop. Everyone stop touching me. I want to stop." Then I could have explained that I was panicking, that this way of proceeding wasn't working for me, and that we had to proceed differently or give me a sedative first. However, I didn't do that - I really don't think I had the presence of mind at that moment to issue a stop order.

Second, I wasn't completely out of control. It's very clear to me that there are deeper levels of panic that I did not reach. One such level might include hitting the medical personnel, and I don't mean accidentally as I was jerking around but actually hitting them, becoming combative. I absolutely was not at that level of panic. Another such level would include being so lost in panic that panic is all there is - my whole world for those moments would consist solely of panic. I was not there, either - I did have some sense of how I was behaving.

Third, I can see from this experience that I react almost instinctually to certain behaviors of others toward me. I instinctually move to protect myself from people doing things to my abdomen (placing patches, for instance) and from having my arms restrained. I do think that those two things can trigger a self-preservation response in people, whether happening singly or together.

Fourth, I think that the combination of things happening to me was overwhelming.

I was lying on my back (a vulnerable position) with people hovering over me.

People were doing things to my abdomen.

People were doing other things to and around me as well.

The potassium going into my arm through the IV was burning.

I couldn't use my arms because they were restrained.

I began to feel that I would faint, even though I was lying down.

Result - panic. People doing things to my abdomen was triggering a self-preservation response, having my arms restrained was triggering a self-preservation response, feeling a burning pain in my arm while unable to move was triggering fear, and feeling that I was going to faint was triggering more fear. When I look at all those individual fear-inducing elements happening at once, I can understand why I would panic.

Fifth, as I think about this, I wonder why on earth I wasn't simply given the sedative before anything was done to me. I do think that this was a judgment error on the part of the doctor, which she did correct as quickly as she could. It does seem to make far more sense to spare any patient the discomfort of these preparatory procedures by administering some sedation - even if the patient isn't panicking. The answer may lie in the real difference between the perspective of the medical personnel and the perspective of the patient.

For medical personnel, this is a routine procedure. Medical personnel routinely apply patches to patients' abdomens, routinely shave patients' pubic hair, and routinely restrain patients' arms during certain medical procedures. For the patient, however, none of this is routine. Patients are not accustomed to having people put things all over their abdomens, may feel embarrassed about being shaved (for me, this was not a problem, especially given everything else that was going on!), and may experience arm restraints as a frightening loss of control. Where medical personnel are having a routine and normal experience, patients are often having a bizarre and alienating experience. I think that doctors and other medical professionals know this intellectually but may not fully grasp it emotionally.

Sixth, I did not effectively communicate the depth of my fear to the medical team. Before the procedure, I described my feelings as "very nervous." I now see that the words "very nervous" were far from strong enough. For any future medical events of this type (and I hope there won't be any!), I plan to say, "I am moving toward a state of panic. I do seriously panic when faced with a medical procedure. I panic as soon as I lie on the table and people begin preparing me by touching me in any way. This means hyperventilating, trembling, jerking, struggling, and crying out. I WILL NEED SEDATION FIRST."

Seventh, I seem to be growing with very small steps in compassion. Rather than judging myself for out-of-control behavior, I can manage to feel compassion for that panic-stricken patient who is me lying on that table in the procedure room. Rather than judging the doctor and the medical team, I can manage to feel compassion for those trying unsuccessfully to help a panicking patient. I don't think that the doctor used the best judgment at first about when to administer the sedative, but I also don't find myself holding anger or resentment toward her or toward the medical team. I find myself able to recognize that they had kindly intentions toward me.

Finally, I thank those who have engaged in deep conversation with me and contributed thoughts that have helped me to see what I have expressed in this post. These include my friends David, Donna Glee, Merry, and Yvonne, and my sister Janet.